In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. Brain death does not (...) disrupt somatic integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)

All-encompassing text examines every aspect of coma from neurochemistry, monitoring, and treatments to prognostic factors.

Conscious awareness comprises two distinct states, autonoetic and noetic awareness. Schizophrenia impairs autonoetic, but not noetic, awareness. We investigated the strategic regulation of relevant and irrelevant contents of conscious awareness in schizophrenia using a directed forgetting paradigm. Twenty-one patients with schizophrenia and 21 normal controls were presented with words and told to learn some of them and forget others. In a subsequent test, they were asked to recognize all the words they had seen previously and give remember, know or guess (...) responses according to whether they recognized words on the basis of autonoetic awareness, noetic awareness, or guessing. Overall, patients showed the same degree of a directed forgetting effect as normal subjects. However, whereas the effect was observed both for remember and know responses in normal subjects, it was observed for know, but not for remember, responses in patients. These results indicate that patients with schizophrenia exhibit an impaired strategic regulation of contents of autonetic awareness for relevant and irrelevant information. (shrink)

Recently, we showed that conscious and unconscious rewards affect the active maintenance of goal-relevant information differently. Here, we elaborate on the mechanisms enabling the boosting or disrupting effects of consciously processed high rewards, and discuss a few methodological and theoretical implications that may be worth considering in future research on the role of reward processing in working memory performance.

This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome. People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others (...) see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem. (shrink)

Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons (...) in minimally conscious state remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity. (shrink)

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to (...) which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: sense of ownership of one’s own thoughts and actions, emotional awareness, distinction between fantasy and reality and the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another. (shrink)

Schizophrenia is a severe mental illness affecting sense of identity. Autobiographical memory deficits observed in schizophrenia could contribute to this altered sense of identity. The ability to give a meaning to personally significant events is also critical for identity construction and self-coherence. Twenty-four patients with schizophrenia and 24 control participants were asked to recall five self-defining memories. We assessed meaning making in participants’ narratives and afterwards asked them explicitly to give a meaning to their memories . We found that both (...) spontaneous and cued meaning making were impaired in patients with schizophrenia. This impairment was correlated with executive dysfunctions and level of negative symptoms. Our results suggest that patients’ difficulties in drawing lessons about past experiences could contribute to explain the lack of coherence observed in their life trajectories and their impaired social adjustment abilities. Implications for psychotherapy are also discussed. (shrink)

I argue that if minds supervene on the intrinsic physical properties of things like brains, then typical human brains host many minds at once. Support comes from science-nonfiction realities that, unlike split-brain cases, have received little direct attention from philosophers. One of these realities is that some patients are functioning (albeit impaired) and phenomenally conscious by all medical and commonsense accounts despite the fact that they have undergone a hemispherectomy: an entire brain hemisphere has been fully detached. Another is (...) the Wada test, in which a patient has each hemisphere anesthetized, one after the other, while the other hemisphere is awake and functioning—again, phenomenally conscious by any standard. I will argue that hemispherectomies, Wada tests, and related procedures each present cases in which the minds that exist after the detachment (or anesthetization) of a hemisphere are surviving minds which must be associated with the surviving (or un-anesthetized) hemisphere. I will argue that such surviving minds existed before the medical procedure, instantiated by the then-intact hemisphere that was due to survive the loss of its complementary hemisphere. If so, then the typical subject has at least three minds: a “left hemisphere mind”, a “right hemisphere mind”, and a “whole brain mind”. But the argument generalizes to cases in which smaller portions of the brain are lost, yielding a great number of additional minds, some overlapping. Some important ethical implications are raised and briefly examined. (shrink)

Impairment of the Self has been described in frontal–temporal dementia but little research has been carried out in patients with Alzheimer’s disease. Objective. The aim of this study was to explore changes in the self in patients with AD. Method. Forty-seven patients with mild to moderate AD were examined using a semi-structured scale designed to assess the self-concept along three dimensions, namely, the Material Self, the Social Self and the Spiritual Self. Results. The majority of patients presented impairment of at (...) least one dimension of the Self. When only one dimension was affected, it was always the Social Self. The severity of impairment of the Self was correlated to the impairment of the semantic autobiographical memory and apathy. The Self is impaired in AD and the Social Self dimension appears to be more vulnerable in AD than other dimensions. (shrink)

Recent studies have shown that schizophrenia may be a disease affecting the states of consciousness. The present study is aimed at investigating metamemory, i.e., the knowledge about one's own memory capabilities, in patients with schizophrenia. The accuracy of the Confidence level (CL) in the correctness of the answers provided during a recall phase, and the predictability of the Feeling of Knowing (FOK) when recall fails were measured using a task consisting of general information questions and assessing semantic memory. Nineteen (...) outpatients were paired with 19 control subjects with respect to age, sex, and education. Results showed that patients with schizophrenia exhibited an impaired semantic memory. CL ratings as well as CL and FOK accuracy were not significantly different in the schizophrenic and the control groups. However, FOK ratings were significantly reduced for the patient group, and discordant FOK judgments were also observed more frequently. Such results suggest that FOK judgments are impaired in patients with schizophrenia, which confirms that schizophrenia is an illness characterized by an impaired conscious awareness of one's own knowledge. (shrink)

This paper argues that the many and various conceptions of consciousness propounded by cognitive scientists and philosophers can all be understood as constituted with reference to four fundamental sorts of criterion: epistemic (concerned with kinds of consciousness), semantic (dealing with orders of consciousness), physiological (reflecting states of consciousness), and pragmatic (seeking to capture types of consciousness). The resulting four-fold taxonomy, intended to be exhaustive, suggests that all of the distinct varieties of consciousness currently encountered (...) in cognitive neuroscience, the philosophy of mind, clinical psychology, and other related fields ultimately refer to a unified natural process, analysed under four general aspects. The proposed taxonomy will, it is hoped, possess sufficient clarity to serve as a sound theoretical framework for further scientific studies, and to count as a significant step in the direction of a properly formulated unified concept of consciousness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:What's in a Name?Steven R. Sabat (bio)Keywordslabeling, mild cognitive impairment, recall memory, selfhood, stereotype threatCorner and Bond (2006) raise a number of important conceptual issues related to the problems involved in defining mild cognitive impairment (MCI), differentiating it from normal aging, the definition of normal aging itself, and ethical issues surrounding the possible adverse effects of a diagnosis of MCI on the individuals thus described. It would (...) seem that portentous ramifications are involved and that clarifying the conceptual issues would be of great value, not only to researchers but also to the ever-growing population of elderly people. In what follows, I address some of these issues further.Problems of Definition and MeasurementOne of the problems that the authors discuss at the outset of their article concerns what methods are appropriate for detecting those with MCI: "Neuropsychological tests alone do not discriminate between normal aged-related memory loss and MCI or dementia and clinical judgment remains central to diagnosis" (Corner and Bond 2006, 5). Of course, to be able to discriminate between normal aged-related memory problems and MCI, we must first be able to define the former. What exactly is normal? As the authors correctly point out, the term has different meanings, one being normative (usual), another being nonpathologic. Is it normal (usual) for some sort of breakdown to occur in brain systems as a function of increased age? If so, is there a threshold age below which the very same physiologic breakdown is unusual? Would such a threshold age, if one existed, be the same for everyone, regardless of genotype and the cumulative interactive effects of nutrition, health, and stress-related factors over a period of decades? In effect, is some sort of memory impairment part of the natural (usual) process of aging for some people at particular ages rather than for others? And exactly what does it mean to be mildly impaired in the cognitive domain?Hogan and McKeith (2001) presented a working group's definition characterizing MCI such that people who complain about memory problems and who also provide objective evidence of such problems, yet who simultaneously display "normal general cognitive function and intact activities of daily living" (Hogan and McKeith 2001, 1131), should be identified and followed. Here again, however, we confront the problem of defining "normal general cognitive function" as well as "normal activities of daily living." Can one have normal general cognitive function without normal memory function? If so, what exactly constitutes [End Page 13] general cognitive function and on what conceptual or theoretical basis is such a definition valid? Furthermore, what sort of memory function are we talking about? Memory can be said to involve a number of stages: encoding, storage, and retrieval. Retrieval can be of the explicit type (conscious recall or recognition of specific information) with which people with Alzheimer's disease (AD) often reveal deficits or of the implicit type (a change in behavior as a result of previous experience of which the person may have no conscious recollection) as demonstrated in people with AD (Knopman and Nissen 1987). That is, people with AD can display deficits in explicit memory functions without similar deficits simultaneously in implicit memory functions.A partial answer to the question about memory loss in MCI may be found in the use of the Mini-Mental State Examination (MMSE; Folstein, Folstein, and McHugh 1975), originally intended to be used as a screening device, but employed more and more frequently as an outcome measure to assess cognitive decline as well as the efficacy of drug treatments. Although the examination purports to test orientation, registration, attention, calculation, recall, language (naming, repeating, reading, writing, three-stage command), and construction, a task analysis reveals that the test is not quite as "global" in the cognitive domain as it is purported to be. For example, ten of the maximum thirty points on the examination are earned for "orientation" in time and place. Yet, all of the questions in this section of the test require intact recall of the relevant information. For example, if a person is asked, "What day of the week is this?" and replies "I don't know," the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Which Kind Is It?Andy Hamilton (bio)Keywordshuman kinds, mild cognitive impairment, multiple personality disorder, practical kinds, social constructionThere is much stimulating material in the Graham and Ritchie's paper (2006), concerning not just disease-classification but also the ethics of diagnosis. My concern is with the way in which they adduce Ian Hacking's views in the philosophy of science in support of their own. The authors quote with approval his (...) "dynamic nominalism" and its influence on Zachar's concept of "practical kinds." Hacking's view, as the authors quote it, is that "People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised" (1995, 21). The act of classifying changes both the classifier and the subject of classification, resulting in facts and categories that are both socially created and real. Hacking calls this "the looping effect of human kinds," and comments that "Multiple personality [disorder] is an almost too perfect illustration of this feedback effect" (1995, 21). The authors comment that Zachar (2000) builds on Hacking's position, discarding essentialist notions of classification that are limited to inherent biological properties, and turning instead to "practical kinds—nonarbitrary cultural artifacts intended to meet pragmatic needs (e.g. therapeutic, predictive prognostic, labeling effects, and physiology)" (Graham and Ritchie 2006, 36). Practical kinds, they believe, offer a way out of the clinical approach focused on mild cognitive impairment (MCI) as a precursor to, or mild form of, Alzheimer's disease. The inclination of the authors, as I read them, is to treat MCI as a practical or human kind, and not, like Alzheimer's disease, as a natural kind.My concern is whether the "looping effect of human kinds" can be transferred to the case of MCI from Hacking's original case study in Rewriting the Soul, multiple personality disorder (MPD). Hacking wished there to undermine the traditional debate over whether MPD is a "social or psychiatric artifact." He claims, correctly I think, that the presupposition behind the question "Is MPD a real disorder as opposed to a product of social circumstances?" should be rejected. The fact that a disorder is a product of social circumstances does not make it less real (1995, 12). On the looping of human kinds, Hacking comments that "The concept of child abuse [implicated in MPD] may itself be so made and molded by attempts at knowledge and intervention, and social reaction to these studies, that there is no stable object, child abuse, to have knowledge about." This is a "no fact of the matter" response, and it [End Page 51] is based on the recognition of conceptual change. He later adds that child abuse "is a real evil, and it was so before the concept was constructed. It was nevertheless constructed. Neither reality nor construction should be in question" (1995, 61, 68). However, Hacking's conclusions about the reality of MPD express only a muted skepticism. Utilitarian skeptics approach this question by asking, "What is the most effective treatment?" Hacking writes that "in their hearts [such skeptics] suspect that the outcome of multiple therapy [therapy that condones or even encourages the development of multiples in the patient] is a type of false consciousness" (1995, 267). The skeptics about MPD are making a moral judgment, he believes; but on whether that moral judgment is correct, he is silent, although the suspicion must be that he agrees with it.How do these considerations apply to the case of MCI? Graham and Ritchie rightly note that classifying a subject as suffering from MCI, and informing them of the diagnosis, will affect them adversely—it will cause suffering not least because there is at present no cure. However, it must surely be conceded that any disease at all—physical or mental—is a social entity insofar as it involves behavioral ascriptions to the subject concerning their incapacity. The authors also note the vested interests—especially from the pharmaceutical industry—in developing a diagnostic category of MCI. These interests are present in the development of any significant diagnostic... (shrink)

Based on recent insight into the thalamocortical system and its role in perception and conscious experience, a unified pathophysiological framework for hallucinations in neurological and psychiatric conditions is proposed, which integrates previously unrelated neurobiological and psychological findings. Gamma-frequency rhythms of discharge activity from thalamic and cortical neurons are facilitated by cholinergic arousal and resonate in networks of thalamocortical circuits, thereby transiently forming assemblies of coherent gamma oscillations under constraints of afferent sensory input and prefrontal attentional mechanisms. If perception is based (...) on synchronisation of intrinsic gamma activity in the thalamocortical system, then sensory input to specific thalamic nuclei may merely play a constraining role. Hallucinations can be regarded as underconstrained perceptions that arise when the impact of sensory input on activation of thalamocortical circuits and synchronisation of thalamocortical gamma activity is reduced. In conditions that are accompanied by hallucinations, factors such as cortical hyperexcitability, cortical attentional mechanisms, hyperarousal, increased noise in specific thalamic nuclei, and random sensory input to specific thalamic nuclei may, to a varying degree, contribute to underconstrained activation of thalamocortical circuits. The reticular thalamic nucleus plays an important role in suppressing random activity of relay cells in specific thalamic nuclei, and its dysfunction may be implicated in the biological vulnerability to hallucinations in schizophrenia. Combined with general activation during cholinergic arousal, this leads to excessive disinhibition in specific thalamic nuclei, which may allow cortical attentional mechanisms to recruit thalamic relay cells into resonant assemblies of gamma oscillations, regardless of their actual sensory input, thereby producing an underconstrained perceptual experience. Key Words: Charles Bonnet syndrome; gamma oscillations; hallucinations; late paraphrenia; Lewy body dementia; perception; schizophrenia; thalamocortical system. (shrink)

Depersonalization is characterised by a profound disruption of self-awareness mainly characterised by feelings of disembodiment and subjective emotional numbing.It has been proposed that depersonalization is caused by a fronto-limbic suppressive mechanism – presumably mediated via attention – which manifests subjectively as emotional numbing, and disables the process by which perception and cognition normally become emotionally coloured, giving rise to a subjective feeling of ‘unreality’.Our functional neuroimaging and psychophysiological studies support the above model and indicate that, compared with normal and clinical (...) controls, DPD patients show increased prefrontal activation as well as reduced activation in insula/limbic-related areas to aversive, arousing emotional stimuli.Although a putative inhibitory mechanism on emotional processing might account for the emotional numbing and characteristic perceptual detachment, it is likely, as suggested by some studies, that parietal mechanisms underpin feelings of disembodiment and lack of agency feelings. (shrink)

Segmentalized consciousness in schizophrenia reflects a loss of the normal Gestalt organization and contextualization of perception. Grays model explains such segmentalization in terms of septohippocampal dysfunction, which is consistent with known neuropsychological impairment in schizophrenia. However, other considerations suggest that everyday perception and its failure in schizophrenia also involve prefrontal executive mechanisms, which are only minimally elaborated by Gray.

We propose an action-oriented understanding of emotion. Emotions are modifications of a basic form of goal-oriented striving characteristic of human life. They are appetitive orientations: pursuits of the good, avoidances of the bad. Thus, emotions are not truly distinct from, let alone opposed to, actions -- as erroneously suggested by the classical understanding of emotions as 'passions'. In the present paper, we will outline and defend this broadly enactive approach and motivate its main claims. Our proposal gains plausibility from a (...) literature- and interview-based investigation of emotional changes characteristic of clinical depression. Much narrative evidence from patient reports points towards the conclusion that many of those changes might result from a catastrophic alteration of the basic form of goal-pursuit at the root of human emotionality. The experience of profound depression could in this respect be a kind of inverted image of non-pathological emotionality--a highly unnatural passivity, giving rise to a profound -- and quite horrifying -- sense of incapacity. (shrink)

Dissociation is a phenomenon common in a number of psychological disorders and has been frequently suggested to impair memory for traumatic events. In this study we explored the effects of dissociation on visual memory. A dissociative state was induced experimentally using a mirror-gazing task and its short-term effects on memory performance were investigated. Sixty healthy individuals took part in the experiment. Induced dissociation impaired visual memory performance relative to a control condition; however, the degree of dissociation was not associated (...) with lower memory scores in the experimental group. The results have theoretical and practical implications for individuals who experience frequent dissociative states such as patients with posttraumatic stress disorder. (shrink)

Gil R, Arroyo-Anllo EM, Ingrand P, Gil M, Neau JP, Ornon C, Bonnaud V. Self-consciousness and Alzheimer’s disease. Acta Neurol Scand 2001: 104: 296–300. # Munksgaard 2001. Objectives – To propose a neuropsychological study of the various aspects of self-consciousness (SC) in Alzheimer’s disease. Methods – Forty-five patients with probable mild or moderate AD were included in the study. Severity of their dementia was assessed by the Mini Mental State (MMS). Fourteen questions were prepared to evaluate SC. Results (...) – No significant correlations were found between SC score and educational level, age, and duration of disease. A significant correlation was found between SC score and the severity of dementia, whereas frontal disturbances were just short of the significance threshold. The various aspects of SC were not impaired to the same degree. The most disturbed ones were awareness of cognitive deficiencies, moral judgements and prospective memory. The least disturbed aspects were awareness of identity and of mental representation of the body. Items relating to anosognosia and moral judgements were significantly correlated with the MMS score, whereas affective state, body representation disorders, prospective memory, and capacities for introspection were not related to the severity of the dementia. Consciousness of identity was sound, regardless of MMS score. Conclusions – AD clearly induces an heterogeneous impairment of SC. SC requires a convergence of many neural networks. In AD, neuronal alterations involve many cortical areas and information sent to the associative frontal cortex from memory, language and visuospatial areas is lacking or disturbed. Thus, the sequential order of successive stimuli cannot be maintained by the heteromodal associative cortex (dorsal convexity of the prefrontal cortex), and the supramodal associative cortex (located rostrally in the frontal lobes) is unable to provide reliable monitoring and assessment of simultaneous neural cognitive networks carrying insufficient and inadequate input. The core deficiency in AD patients might be impaired SC equated with the disability to maintain sequential and simultaneous ‘‘attention to life’’. The Self-Consciousness Questionnaire, a clinical scale providing multidimensional measurement, indicates that different aspects of consciousness are not correlated with overall cognitive deficiency as determined by the MMSE. (shrink)

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. -/- This book examines the entanglement of (...) epistemic and ethical uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents. (shrink)

A broad pattern of correlations between mechanisms of brain function impairment and self-transcendence is shown. The pattern includes such mechanisms as cerebral hypoxia, physiological stress, transcranial magnetic stimulation, trance-induced physiological effects, the action of psychoactive substances and even physical trauma to the brain. In all these cases, subjects report self-transcending experiences o en described as ‘mystical’ and ‘awareness-expanding,’ as well as self-transcending skills o en described as ‘savant.’ The idea that these correlations could be rather trivially accounted for on the (...) basis of disruptions to inhibitory neural processes is reviewed and shown to be implausible. Instead, this paper suggests that an as-of-yet unrecognized causal principle underlying the entire pattern might be at work, whose further elucidation through systematic research could hold great promise. (shrink)

Postulating the subcortical organization of human consciousness provides a critical link for the construal of pain in patients with impaired cortical function or cortical immaturity during early development. Practical implications of the centrencephalic proposal include the redefinition of pain, improved pain assessment in nonverbal humans, and benefits of adequate analgesia/anesthesia for these patients, which certainly justify the rigorous scientific efforts required. (Published Online May 1 2007).

Patricia Churchland's Touching a Nerve: The Self as Brain is her most recent wide-ranging argument for mind-to-brain reductionism. It's one of the leading anti-dualist works in neurophilosophy. It thus deserves careful attention by anti-reductionists. We survey the main arguments in this book for her thesis that the self is nothing but the brain. These arguments are based largely on the self's dependence upon neural activities as reflected in its various impairments, its unified experiences, and its powers of agency. We show (...) that dualism is quite compatible with this neural dependence. We argue that dualism can not only counter--but also turn the tables on--her arguments. Unlike most other critics, we focus not only on her hard problems but also on her easy problems in explaining consciousness. A new non-Cartesian substance dualism is presented that avoids existing dualist causal issues. It may thus avoid perennial physicalist and dualist problems. -/- . (shrink)

A brief self-report scale was developed to assess everyday performance failures arising directly or primarily from brief failures of sustained attention . The ARCES was found to be associated with a more direct measure of propensity to attention lapses and to errors on an existing behavioral measure of sustained attention . Although the ARCES and MAAS were highly correlated, structural modelling revealed the ARCES was more directly related to SART errors and the MAAS to SART RTs, which have been hypothesized (...) to directly reflect the lapses of attention that lead to SART errors. Thus, the MAAS and SART RTs appear to directly reflect attention lapses, whereas the ARCES and SART errors reflect the mistakes these lapses are thought to cause. Boredom proneness was also assessed by the BPS, as a separate consequence of a propensity to attention lapses. Although the ARCES was significantly associated with the BPS, this association was entirely accounted for by the MAAS, suggesting that performance errors and boredom are separate consequences of lapses in attention. A tendency to even extraordinarily brief attention lapses on the order of milliseconds may have far-reaching consequences not only for safe and efficient task performance but also for sustaining the motivation to persist in and enjoy these tasks. (shrink)

An historical review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action) and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-nonself differentiation. Furthermore, the social other, through very early social and emotional interactions, provides meaning to the infant’s perception and contributes to the development (...) of his/her symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using the mirror as an experimental paradigm to study self- and other- image and body recognition. (shrink)

Mental health, in one awake, guarantees that person knowledge of the central phenomenon-contents of his own mind, under an adequate classificatory heading. This is the primary thesis of the paper. That knowledge is not itself a phenomenon-content, and usually is achieved in no way. Rather, it stems from the natural accessibility of mental phenomenon-contents to wakeful consciousness. More precisely, when mental normality obtains, such knowledge necessarily obtains in wakeful consciousness. This thesis conjoins a version of Cartesianism with the (...) concepts of mental health and human nature. Demonstration of the thesis requires that we show that a particular human mental potential fails fully to be realized when such self-awareness is impaired. That potential is for consciousness of the world (w-Cs), wakefulness. W-Cs divides into consciousness of the outer world (ow-Cs), and consciousness of the inner world (iw-Cs), and we need to demonstrate an essential dependence of ow-Cs upon iw-Cs. Now w-Cs is the adoption of the correct occurrent epistemological posture to the world, and this involves free rational determination of occurrent cognitive attitudes via the internal systematized knowledge of the world, which requires adequate awareness of mental phenomenon-contents. Therefore ow-Cs needs iw-Cs. This is displayed in mental structural accounts of hypnotic, drunken, and psychotic disturbances of consciousness. (For we endorse a structural account of mental health.) We show how failures of self-consciousness entail disturbed modes of determination of cognitive attitudes by the knowledge-system, which is loss of contact with the personal yet true internal representation of the world, which is loss of contact with reality, which is a disturbance both of w-Cs and of consciousness itself. (shrink)

Memory is a general attribute of living species, whose diversification reflects both evolutionary and developmental processes. Episodic-autobiographical memory is regarded as the highest human ontogenetic achievement and as probably being uniquely human. EAM, autonoetic consciousness and the self are intimately linked, grounding, supporting and enriching each other’s development and cohesiveness. Their development is influenced by the socio-cultural–linguistic environment in which an individual grows up or lives. On the other hand, through language, textualization and social exchange, all three elements leak (...) into the world and participate to the dynamic shaping and re-shaping of the cultural scaffolding of the self, mental time traveling and EAM formation. Deficits in self-related processing, autonetic consciousness, emotional processing and mental time traveling can all lead to or co-occur with EAM disturbances, as we illustrate by findings from EAM impairments associated with neurological or psychiatric disorders. (shrink)

In his interesting commentary, Joshua Shepherd raises two points—one related to epistemology, the other to ethics—about our article on human cerebral organoids.1 2 From the epistemological standpoint, he calls into question the need for a theory of consciousness. A theory of consciousness, for him, is not necessary because of the lack of consensus about the very nature of consciousness. Shepherd suggests that ‘given widespread disagreement, applying a theory of consciousness may not be helpful when attempting to (...) diagnose the presence of consciousness in cerebral organoids’. In Shepherd’s view, it would be better to transfer ‘concepts already under development in work on the presence and structure of consciousness in difficult marginal cases involving traumatic brain injury’.2 We could not agree more on this last point; detecting a minimal capacity for consciousness in the brain of comatose patients is a very similar challenge to inferring the presence of consciousness in cerebral organoids. Every day, as a by-product of saving many lives, intensive care medicine artificially produces thousands of brains that may remain isolated, split or fragmented; in the worst case, cortical islands, or an archipelago of islands, may survive while being disconnected from the outside world. Can these islands host some form of consciousness? That is, does it feel like anything to be a large piece of human cortex? Addressing this difficult question requires the development of general, objective brain-based indices of consciousness that are independent of sensory processing, executive functions and motor outputs.3 Consider, for example, a patient showing reflexive spontaneous behaviour, no response to command and no ability to communicate. In her brain, afferent pathways are damaged, thereby impairing the recruitment of cortical areas in response to sensory stimulation; basal ganglia, as well as other frontal structures supporting executive functions, are impaired. However, resting metabolism and significant electroencephalography …. (shrink)

Encoding sensory events entails processing of several physical attributes. Is the processing of any of these attributes a pre-requisite of conscious awareness? This selective review examines a recent set of behavioral and event-related potentials, studies conducted in patients with visual and auditory unilateral neglect or extinction, with the aim of establishing what aspects of initial processing are impaired in these patients. These studies suggest that extinguished visual stimuli excite the sensory cortices, but perhaps to a lesser degree than acknowledged (...) stimuli do. However, encoding spatial attributes of auditory and visual stimuli appear to be preferentially impaired. In light of results from patients with other neuro-behavioral deficits, it is argued that egocentric spatial information is an essential pre-requisite for knowing that an external event occurred. In contrast, information handled by mostly domain-specific circuits, such as in the ventral temporal lobe, supports awareness of the identity of a stimulus, but not of its mere presence. Without spatial information, the stimulus identity will remain implicit. (shrink)

Objective: The value of spontaneous EEG oscillations in distinguishing patients in vegetative and minimally conscious states was studied. Methods: We quantified dynamic repertoire of EEG oscillations in resting condition with closed eyes in patients in vegetative and minimally conscious states (VS and MCS). The exact composition of EEG oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. Results: The probability of delta, theta and slow-alpha oscillations occurrence was smaller for patients in MCS than for VS. Additionally, only (...) patients in MCS demonstrated fast-alpha oscillation occurrence. Depending on the type and composition of EEG oscillations, the probability of their occurrence was either aetiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different aetiologies. Conclusions: Spontaneous EEG oscillations have a potential value in distinguishing patients in VS and MCS. Significance: This work may have implications for clinical care, rehabilitative programs and medical–legal decisions in patients with impaired consciousness states following coma due to acute brain injuries. (shrink)

One oft the most fascinating abilities of humans is the ability to become conscious of the own physical and mental states. In this systematic investigation of self-consciousness, a representational theory is developed that is able to distinguish between different levels of self-consciousness. The most basic levels are already present in such simple animals as ants. From these basic forms, which are also relevant for adult human self-consciousness, high-level self-consciousness including self-knowledge can arise. Thereby, the theory is (...) not only able to integrate developmental considerations but also to sharply distinguish different aspects of the complex phenomenon self-consciousness. Pathological breakdowns of these different aspects, as they can be found in schizophrenia, are explained by specific impairments on different levels of self-representation. In this way, the work shows that a naturalistic theory of self-consciousness is possible, if the analysis starts with very simple and basic mechanisms instead of starting on the »top of the iceberg«. (shrink)

Dr. Vukov analyzing patients with disorders of consciousness, proposed that medical well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness (minimally conscious state – MCS versus vegetative state – VS), but that they can be justified by looking to patients’ potential for consciousness. One objective way to estimate this potential (actual physical possibility) is to consider a neurophysiologically informed strategy. Ideally such strategy would utilize objective brain activity markers of consciousness/unconsciousness. (...) The Operational Architectonics (OA) theory of brain-mind functioning is an example of such a strategy. Besides being mathematically simple, neurophysiologically accurate, and compatible with the cognitive/phenomenal perspectives on consciousness, application of OA strategy to quantitative EEG analysis of patients in VS and MCS revealed that the absence of consciousness in VS is paralleled by impairment of overall EEG operational architecture. Specifically, neuronal assemblies become smaller, their life span shortened, and they became highly unstable and functionally disconnected (desynchronized). At the same time, fluctuating (minimal) awareness in patients in MCS was paralleled by partial restoration of EEG operational architecture (increased size, life span, and stability of neuronal assemblies, together with an increased number and strength of functional connections among them), approaching the level found in healthy fully conscious participants. Moreover OA strategy to EEG analysis allowed predicting the emergence of consciousness in VS patients after six years following the brain trauma. Therefore, the OA methodology could reliably predict which patients may regain consciousness, and thus determine which patients may have the potential for consciousness. (shrink)